A Tularemia Case with Bilateral Inguinal Lymphadenopathy and Abdominal Abscess

Grassie S. S., Kilic S., Kilickalp G., Ocak F., Akturan S., Kayaaslan B.



Tularemia is a zoonotic disease caused by Francisella tularensis. Humans can acquire the infection through bites from arthropods, contact with animal tissues, consumption of the infected water and inhalation of aerosolized bacteria. The oropharyngeal form is the most common presentation in Turkey, reflecting the consumption of contaminated water. While the most common complication of the disease is the suppuration of the lymph nodes, abscess formation can be a very rare complication. In this study, we report a glandular tularemia case with bilateral inguinal lymphadenopathy and intra-abdominal abscess. A 51-year-old woman came to the infectious diseases clinic with fever and swelling in the groin ongoing for two months. She had been started on a treatment of amoxicillin-clavulanic acid at another hospital for two weeks and had a history of watering her garden bare feet with natural pool water. She had fever and bilateral inguinal lymph nodes in her physical examination. One of her lymph nodes was extracted for diagnosis. The pathological examination result was granulomatous lymphadenitis. The sample's culture and PCR results were negative for tuberculosis and tularemia but the E tularensis microagglutination test (MAT) was positive. She had received treatment for Tularemia but her clinical and laboratory findings had not improved. Pelvic lymphadenopathies and an intra-abdominal abscess were observed in an MRI. Percutaneous drainage was done and the patient's condition improved. This tularemia case was presented to emphasize that in regions, like our country, where tularemia is epidemic, if specific treatment is late, rare complications can be seen.